AB0537 RITUXIMAB THERAPY IN LUPUS NEPHRITIS RESISTANT TO CONVENTIONAL THERAPY – A SINGLE CENTER EXPERIENCE (CASE SERIES)
Authors: E. Firat Senturk, H. Ogun, I. Durucan, B. Yurttas, S. Ugurlu
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Lupus nephritis(LN) can be a cause of morbidity and mortality in a significant portion of patients. The treatment of lupus nephritis can be challenging in some patients who are resistant to conventional immunosuppressive treatment. <h3>Objectives</h3> Rituximab is a promising agent for treating resistant LN patients. We evaluated the response of LN patients who were treated with rituximab treatment in our clinic retrospectively. <h3>Methods</h3> We evaluated LN patients who were followed and treated with at least one course of rituximab in our clinic between 2010-2022. LN was confirmed by renal biopsy. Creatinine clearence, serum creatinine, 24- hour proteinuria and Systemic Lupus Erythematosus- Disease Activity Index- 2000 (SLE-DAI-2K) were analyzed before and after Rituximab treatment. Primary end point was current prednisolone dose ≤5 mg and 24-hour proteinuria ≤ 500mg. Also, we evaluated the side effect of rituximab. <h3>Results</h3> Forty seven patients (34 F, 13 M) were treated with rituximab. All patients had active lupus nephritis at initiation. Mean of disease duration was 10.44 ± 6.9 years. All patients were initally treated with high dose steroids. The other medications, the patients were previously treated with, were cyclophosphamide (n= 35), mycophenolate mofetil (n= 31), azathioprine (n= 6), cyclosporine (n= 2). Patients received an average of 4.1 ± 3.68 courses of rituximab (Table 1). The median value of pre-treatment proteinuria was 3050 (1370, 5175) mg/day. The median value of proteinuria after the final course was 747 (396, 1500) mg/day (p&lt; 0.01). Serum creatinine level was changed from 0.94 ± 0.59 to 0.98 ± 0.68 (p= 0.53). Mean serum creatinine clearence was increased from 102.01 ± 43.2 to 109.1 ± 51.3 (p=0.28). Mean SLE-DAI-2K was reduced from 16.3 ± 6.2 to 7.2 ± 4.8 (p&lt; 0.01). While initial steroid dose was 24.13 ± 18.47 mg/day, steroid dose at last rituximab course was 7.5 ± 5.8 mg/day (p&lt; 0.01). End stage renal disease was developed in 3 (%6) patients. For primary end point of view, currrent prednisolone dose ≤ 5mg and 24-hour proteinuria ≤ 500 mg were achieved in %53.1, %36.1 of patients respectively. Both criteria was met by %25.5 of patients. During the treatment, 2 patients had serum reaction, 3 had pneumonia, 3 had herpes zoster. Three patients had hippogamaglobulinemia and treated with intravenous immunoglobulin. No one was died of lupus nephritis. <h3>Conclusion</h3> In lupus nephritis patients resistant to conventional therapy, rituximab can be tried as an alternative treatment choice. In our single center, most of the patients were class IV nephritis whom we observed the efficacy of rituximab. Generally, the side effects were acceptable. Rituximab could be a good option as a steroid reducing agent and exhibit a favorable clinical response in these patients. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.